A Healthcare Cfos burden is to always maintain the expenses according to the profits received. Sometimes CFOs forget all revenues received by a hospital or clinical group by billing out claims for the services rendered by the respective physician or department. Forgetting why the so-called revenue leaks are happening and encouraging them to provide more and more services does not make sense because there is already tens of thousands of dollars pending with the insurance companies unpaid. These are not only denials but certain elements which take only minor tweaking in the electronic payments side of the hospital or clinical group. 

We have encountered various clinical groups and hospitals that make the same mistakes of not monitoring electronic payment set up for all the insurance companies they are in network with. They still use manual methods to receive payments from insurance companies and necessary reconciliation outside the PMS or EHR they might have. This not only slows the entire reimbursement process, but also creates a lot of confusion if the patient volumes are higher than average. A well performing hospital or clinical group with 100 beds will always face this endeavor when it comes to manual paper payment documents.

The best way for any CFO to play an active part in the electronic reimbursement of their practices is to have access to Enrollhub and the designated Clearing House they use. If the CFOs think that enrolling with various insurances through Enrollhub might be a time consuming and complicated process, but it is not true. Here’s how Enrollhub enrollment process takes place:

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A number of local and nationwide health insurance plans are currently networking in EnrollHub, and as always new insurance plans continue to join everyday, some. Of. The famous payer examples are:

An astonishing number of 200,000 Healthcare Organizations and providers are already participating, and thousands more join each month.

An user friendly Web portal based operating layouts and design enables CFOs and providers to easily enter their EFT enrollment information. Enrollhub has the option of aligning with CORE ERA / EFT Operating and functional rules for definition of the usual or standard enrollment data set and supporting documentation. The support center for providers and designated office faculty responsible for electronic transactions addresses all questions, concerns and assists them with the enrollment process. It also has the feature to easily upload documents electronically, including a voided check, bank letters etc. 

Another favorable option which is appreciated by all CFOs and providers is Pre-note transactions via ACH partners to verify bank account information, before sending payment through. Health insurance plans access enrollment information through a web portal based site or API. The CAQH networks  with the insurance plans to conduct educational and informational campaigns, webinars and events to encourage greater participation and networking by all CFOs, hospital administrators and healthcare providers.

One-to-Many Solution gives single user friendly easy-to-use point of entry for healthcare organizations to enroll in EFT and ERA and manage enrollment information with multiple insurance companies. Absolutely “No Cost”. There is no charge for providers to use; participating with insurance plans pay a low fee to cover the costs to develop and run the solution. Completely secure, robust encryption, firewalls and strong password creation requirements protect sensitive data. Healthcare organizations and providers have full control of their data at all times. It is very flexible and only focused on enrollment which enables healthcare organizations and providers to use their preferred downstream payment processing or ERA (remittance advice) presentation solution.

According to the ACA-mandated CAQH CORE EFT & ERA Operating and functional Rules includes requirements to make it easier for healthcare organizations and providers to receive both ETF (claim reimbursements) and ERA (remittance advice) electronically.These rules require insurance plans to transmit a trace number within the EFT so that CFOs and providers can match it to a trace number in the association ERA. (TRM Reassociation Trace Number Data Segment). Banks and other financial institutions are required to deliver this data through a secure, electronic means. Reimbursement data is not necessarily sent automatically; a request may be required. The CAQH CORE has provided a sample letter to the designated provider to send to the healthcare organizations or providers bank account. CAQH CORE has necessary resources readily available to assist healthcare CFOs, organizations and providers on this tailored website.

When it comes to electronic payment methods in most cases, ERAs can be requested at the same time as EFTs through ACH. The designated bank is required to deliver ACH remittance data to your healthcare organizations EHR, PMS and clearinghouses practice. However, If the bank denies this request, contact NACHA, which governs the ACH network. Talk to your clearinghouse or other electronic payment vendors. Communication and cooperation between all parties involved in the EFT transaction process such as healthcare organizations, practices, clearinghouses, financial institutions, banks practice management systems, EHRs is important for a smooth transition. Requesting your clearinghouse and practice management system if they can support EFT/ERA reconciliation and auto-posting.

BillingParadise has fixed up many holes in the revenue leaks that CFOs face each month. We keep these CFOs of client hospitals and clinical groups appraised on the electronic payments they’re receiving through daily, weekly and monthly financial reports which compares to the manual paper check reimbursement rates and electronic ones. We are also suggesting these CFOs to utilize our Eligibility and benefits verification systems, ERA consolidation systems to pay closer attention to the patient and payment trends. Our home grown productivity and analysis tool “Team Billing Bridge” will also notify them to pay attention to any tickets or queries raised by the in house billing staff to solve certain payment issues, this way allround communication between the billing department and the CFOs or financial departments can work together to achieve higher reimbursement rates by reducing the operational costs. 

Talk to our experts and learn more on how your healthcare organizations can avoid manual payment documents.